House advances Medicaid expansion bill, but ultimate passage still unlikely

AUGUSTA, Maine — The Maine House of Representatives on Tuesday voted 97-49 to pass a bill aimed at expanding Medicaid to more than 70,000 low-income Mainers as part of the federal Affordable Care Act.

That vote is enough to send the bill back to the Senate for a final vote. However, the vote indicates support for the bill is not strong enough to override a certain gubernatorial veto. The bill found a similar fate in the Senate last week.

The bill faces additional votes in both chambers. LePage has said he will veto the bill if it crosses his desk.

On paper, the bill addresses many of the concerns Republican opponents of expansion have raised for two years: The expansion lasts only as long as the federal government pays for nearly 100 percent of the cost, and it would require a vote of the Legislature to continue beyond that. It also includes an automatic opt-out if federal funding drops below promised levels. The Legislature’s nonpartisan budget analysts say the cost of the proposal is minimal.

It also uses built-in savings to clear our a waiting list of Medicaid recipients awaiting in-home and community services, which opponents have said need to be addressed before the program is expanded to include all of Maine’s poorest residents.

Still, the bill has struggled to gain Republican support. In the Senate, Katz and Saviello were the only members of their caucus to support the bill. Even Sen. Patrick Flood, R-Winthrop, who voted for Medicaid expansion last year, opposed the measure.

The arguments made during the more than four-hour debate on the House floor were largely the same that had been made for years, with Democrats framing the issue as an offer to provide life-saving health insurance to thousands of Mainers, create jobs and and pump $1 million per day into Maine’s economy. Republicans decried the plan as reckless growth of an already bloated state Medicaid program, and predicted dire financial outcomes and budget shortfalls if the bill is passed.

Rep. Heather Sirocki, R-Scarborough, said the bill reminded her of a Trojan horse. The benefits promised by Democrats are “tempting, but if we open the gates and accept this package, I anticipate significant surprises,” she said.

Ultimately, every Democrat and independent in the House voted in favor of the Katz-Saviello plan, and four Republicans joined them: Reps. Matt Pouliot and Corey Wilson, both of Augusta, plus Jarrod Crockett of Bethel and Ellen Winchenbach of Waldoboro. Five Republicans were absent.

Wilson was a sponsor of the bill. Winchenbach and Crockett were also both known supporters, but Pouliot’s support came as a surprise to some.

The Augusta lawmaker had recently joined opponents of the bill in emphasizing that roughly two-thirds of those eligible under expansion are already eligible for subsidized, private health insurance plans through online exchanges.

But thanks to a loophole created when the U.S. Supreme Court ruled that states could choose whether to expand Medicaid, the poorest people — those who make less than 100 percent of the federal poverty level, or about $11,500 for a childless adult — are not eligible. And federal law does not allow states to expand to only a portion of the population — it’s all or nothing.

Pouliot decried the partisanship on display leading up to the Medicaid expansion debate, and said he “must go with what my heart tells me to do.”

“Ideology knows the answer before the question has been asked. Principles are something different. They are a set of values that have to be adapted to new circumstances,” he said. “This is a vote for those people from zero to 99 percent [of the federal poverty level.] These are the people in the equation that have kept me up at night.”

Last week, the bill passed the Senate, 22-13, enough to advance the bill to the House, but not enough to override a certain veto by Gov. Paul LePage, one of the plan’s fiercest critics.

The bill faces final votes in the House and Senate, which will likely come this week. If the numbers hold, that means the measure will go to LePage, who has sworn to veto it. An override would require two-thirds of those present and voting in both chambers.

That means for the bill to become law, not only must the current proponents hold their ground, but supporters in the House must win four more Republicans, while those in the Senate must convince two of their GOP colleagues to support the bill.

In a release sent after the votes were cast, House Republicans said prospects for the bill becoming law “look bleak.”

“I’m cautiously optimistic that we’ll be able to sustain the governor’s veto of this fiscally irresponsible bill,” said House Minority Whip Alex Willette, R-Mapleton. “We’re trying to reduce welfare spending in Maine, not increase it.”

Democrats, meanwhile say the fight is not yet over.

“I’m proud of the vote and the debate today,” said House Speaker Mark Eves, D-North Berwick. “Democrats, Republicans and independent proponents of health care had a positive message about saving lives and helping our economy. We will continue that fight as long as it takes.”

If the Katz-Saviello plan does fail, Democrats have two other Medicaid expansion bills — one by Eves and another by Senate Majority Leader Troy Jackson — waiting in the wings, although there has been no indication whether those bills would be run or indefinitely postponed if the Katz-Saviello plan dies.